Health Care Reform's First Provisions Start

As her 22-year-old daughter faces major surgery, Carol Malnick of Los Altos has at least one less thing to worry about: its stratospheric price tag.
Significant provisions of the health care overhaul bill roll out Thursday, reshaping the insurance landscape by significantly broadening access to coverage and care.
Now, young adults may remain on their parents' policies until age 26 and minor children can't be denied coverage because of pre-existing conditions. Insurers are prohibited from canceling coverage for sick patients or those who have reached coverage limits -- when they need it most.
"Thank God. It is financial security," said Malnick, whose daughter Meredith needs jaw reconstruction, at an estimated cost of $120,000, to correct lifelong sleep apnea and insomnia. She'll still pay thousands of dollars toward the cost of care -- but without Meredith's coverage, "I would be looking to sell my house," she said.
The changes are also good news for Martinez native Julie Walters, whose daughter, Violet, was born two years ago with a rare and life-threatening form of epilepsy. The bills for Violet's hospital stays have reached hundreds of thousands of dollars -- and the baby would have reached the lifetime limit on health insurance by the age of 4.
Even more dramatic reforms, such as full expansion of Medicaid, won't take effect until 2014. But six months after passage of the federal Patient Protection and Affordable Care
Advertisement Act, several big changes start now.
For instance, insurers must cover recommended preventive services, such as mammograms and flu shots, with no co-pay. When people need emergency care while traveling, they can seek treatment at the closest place, without having to worry about out-of-network surcharges.
"The provisions going into effect on September 23 can have a profound impact on the health of California families," said Dr. Gerald Kominski, associate director of the UCLA Center for Health Policy Research.
Mountain View insurance broker Chris Acker also welcomed the reforms. "Any legislation that allows people to protect themselves financially is good legislation," he said. "It will most benefit those people who are not healthy," he said.
Many critics of overall reform, including several prominent members of the Republican Party, are especially opposed to a mandate that everyone obtain insurance, which will take effect in 2014. Those who oppose expanding coverage fear it could significantly cost employers more in financial outlay, according to health management consultant Stephen Beckley in Fort Collins, Colo. Some health insurance companies are already raising their rates as much as 10 percent, blaming federal health reform law.
But U.S. Health and Human Services Secretary Kathleen Sebelius warned a health-insurer trade group last week not to use the Affordable Care Act to game the system. The administration estimates that the changes should raise costs no more than 2 percent.
Surveys show that young adults are the largest group of patients to lack health insurance -- and even healthy youngsters can break a leg in a ski accident, for instance, and face catastrophic bills. About half of all colleges offer insurance -- but many are poor quality, excluding important services. Young people with coverage tend to be on their parents' employer-sponsored plans -- the cheapest, best regulated and most comprehensive option, experts say.
Until now, they've lost coverage when they turn 21 or graduate from college. And many entry-level jobs don't offer insurance. Nor do most graduate schools.
Healthy young adults can find individual plans on the open market, averaging $150 a month. But those with even minor pre-existing problems, such as asthma, may face much higher rates.
"It will help those who have to choose between paying for medical insurance, or paying for other important things," Acker said. "Young adults -- they tend to pay their car bill first."
And patients like Meredith Malnick -- an English literature student now on leave from the University of Oregon, who loves to ski, hike and ride horses -- find it tough to get any insurance, due to previous procedures.
There are some caveats. For instance, some employers' plans created before the reform act will be "grandfathered in" and don't have to abide by the new requirements.
The provisions kick in when parents' plans renew. For some, that's Sept. 1; for others, it's Jan. 1.

If we had done nothing, as we had been doing for years, you know damn well rates would have continued to rise and people (even you) would have continued to complain and yet nothing would have gotten accomplished. One can choose to look at the positive aspects of the new measures or just complain how everything isnt perfect. Its always so much easier to just complain. You have gotten very good at that, but i never see your real world solutions.

Rates are always going to go up. Its a question of how much. And i hope you do know that the main part of the health care bill doesnt come into effect until 2014. We will just have to debate into the future whether these rate increases are a result of these new measures, or an attempt to push rates up and blame it on a bill most insurance companies opposed. We know which side your on. LOL.

Such a shame you cant see some of the good of these new provisions, including the fact that the
non -partisan CBO says the bill will help cut the deficit by trillions of dollars over many years.
You are for cutting the deficit right? LOL.

Obama touts new patient protections in health-care reform
Several patients' rights provisions of the new health-care reform law go into effect Thursday. President Obama is still working to sell the American public on the merits of the reforms.

By Linda Feldmann, Staff writer / September 22, 2010

Six months ago Thursday, President Obama signed landmark health-care reform – and he’s still trying to sell it.
Much of the public was skeptical of the reform in March, and remains so now. Many Republicans are campaigning on a pledge to repeal it. The more immediate threat, while Mr. Obama and his veto pen are still in the Oval Office, is to defund implementation. Twenty states are suing in federal court to have the reform declared unconstitutional.

To counter all the negative publicity, and try to win converts to the reform, Obama and other top administration officials spent Wednesday touting the patients’ rights features going into effect Thursday.

They are “the most important patients’ bill of rights that we’ve ever seen in our history,” Obama said Wednesday at a “backyard discussion” in Falls Church, Va., which included average people who will benefit from the reforms.

The new provisions apply to plan years that begin on or after Sept. 23:

Insurance companies are barred from dropping clients who become ill.
Family plans may cover adult children up to age 26.
Insurers are barred from denying coverage to children up to age 19 because of preexisting conditions.
New plans are required to cover preventive care, such as mammograms and colonoscopies, with any copays or deductibles.
Lifetime caps on coverage are eliminated, and annual caps begin to phase out.
Taken separately, all these features are popular. But opponents of so-called “Obama-care” have pounded away at the individual mandate to carry coverage (the subject of the lawsuits) and various fears: that people will be forced to change doctors, that the cost of health-care premiums will skyrocket, and that the cost of reform will burden the federal government with higher deficits and debt.

Obama maintains that none of those concerns will come to pass. Over the long term, he said at the Falls Church event, premiums will be lower than they would be otherwise, because of the preventive care features of the reform.

“Health care costs overall are going to be lower than they would be otherwise,” Obama continued. “And that means, by the way, that the deficit is going to be lower than it would be otherwise.”

The president then cited an analysis by the nonpartisan Congressional Budget Office that found that, as a result of the Affordable Care Act, the deficit will be more than a trillion dollars lower over the next 20 years than if the law had not passed.

On Wednesday, the White House also unveiled a new website, www.WhiteHouse.gov/HealthReform, which explains the new law and contains the stories of Americans from all 50 states who are benefiting from it.

The big White House push on the six-month anniversary of enactment reflects a tacit acknowledgment that the Obama administration has lost the public relations war over health-care reform. Further evidence comes in the campaigns of Democrats around the country, few of whom are touting health-care reform in their stump speeches. Administration officials are hopeful that, over time, people will see a positive impact from the reform and that opposition will die down.

But with unemployment stubbornly high, Americans are not in much of a mood to see positives in Obama’s support for health-care reform. In fact, at a time when the economy and jobs remain the No. 1 concern of voters, talk of health-care reform seems almost off-message. But as the biggest piece of legislation passed in an eventful first two years in office, Obama is loath to back away from it.

Republicans are happy to pile on, highlighting press coverage that focuses on health insurance rate hikes around the country, in part because of the reforms.

"It seems the more Americans say they want Democrats to stop what they're doing and focus on jobs and the economy, the more determined they are to press ahead with their various liberal agenda items while they've still got the chance," Senate minority leader Mitch McConnell of Kentucky said in a statement.

Yesterday, Nancy-Ann DeParle of the Office of Health Reform joined bloggers for a conference call to highlight the provisions of the Affordable Care Act that go into effect tomorrow, six months after enactment of the law. Those changes:

Ban on discriminating against children with preexisting conditions: as of tomorrow, insurance companies can't deny coverage to children under age 19 for a pre-existing condition. The ban will go into effect for adults in 2014.
Ban on rescission: insurers will be prohibited from dropping a customer when they get sick or to search for errors in customers' applications to use as a basis for rescinding coverage or denying payment for services.
Ban on limiting coverage, lifetime caps: Insurers will no longer be able to impose lifetime dollar limits on benefits--particularly hospital stays or expensive treatments for chronic diseases, cancer, etc. By 2014, they will phase out annual caps.
Ban on limiting doctor choice in new plans: insurers will have to allow primary care physician status for OB/GYNs and pediatricians so that patients don't have to get pre-authorization or referrals to see these providers.
Ban on restrictions on emergency services: insurers will have to cover all emergency care, in or out of network.
Guaranteed right to appeal insurer decisions to independent third party in new plans;
Young adults can stay on their parents' plans til 26 unless they have access to coverage in their workplace;
New plans will cover preventive care with no customer costs--well-baby, mammograms, colonoscopies, etc. will be covered with no co-pays or deductibles.

A provision of the health care bill that bars health insurers from refusing to cover sick children with pre-existing conditions will go into effect on Thursday, and several of the nation’s largest health insurers, anticipating the change, have found a way to avoid bearing the law’s full effect.

Many have dropped child-only policies altogether, in states where they’re allowed to. Because the health care overhaul prevents insurers from turning down coverage of kids, insurers are afraid parents will wait until their children are sick to enroll them. In August, the Obama administration issued a clarification, allowing insurers to restrict enrollment of children to particular “open enrollment” periods, if allowed by state law.

Apparently, that wasn’t enough for the insurance companies. WellPoint’s Anthem Blue Cross & Blue Shield, Aetna, Cigna, CoventryOne, Humana, and UnitedHealth Group’s UnitedHealthCare have all said they will stop writing new child-only policies in one or more states, according to reports from Dow Jones Newswires and The Hill. The affected states include Colorado, California, Ohio, and Missouri.

Here’s The Hill, explaining what this decision could mean:
The announcement could lead to higher costs for some parents who are buying separate coverage for themselves and their children at lower cost than the family coverage that's available to them.

The Obama administration has criticized the insurers for turning their backs on “some of our most vulnerable Americans.” (Children covered by existing child-only policies will continue to receive coverage.)

A Department of Health and Human Services spokeswoman told Politico,“Insurance companies have pledged to offer coverage to children with pre-existing conditions, and we expect them to honor that commitment.”

Insurers have said their decision to drop child-only coverage was prompted by uncertainty in the health insurance market. Dow Jones cited WellPoint’s response, for instance:

We have reviewed the rules regarding the provisions of the Patient Protection and Affordability Care Act (PPACA) limiting the application of pre-existing condition exclusions for children under 19," WellPoint said in a statement. "Unfortunately, there remains a great deal of uncertainty as to how the rules will be implemented and what the impacts might be on participating insurers.

"While some carriers may continue to offer child-only policies, other carriers have dealt with this lack of clarity by choosing to discontinue new business sales of their child-only policies. Some have cited the lack of an effective mandate for individuals to obtain coverage, as well as ongoing market uncertainty," WellPoint said.

Cigna’s vice president of public policy, G. William Hoagland, told Politico that the company “would love to stay in the market” for child-only coverage, but “you can’t have guaranteed issue for this population and be the only one out there.”
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"You have gotten very good at that, but i never see your real world solutions."

That is untrue. I have presented many ideas. Just take a look back. One idea was to build federal heath centers where the most unisured lived. The idea was to create assets and jobs while solving the problem for the uninsured.